Provider Demographics
NPI:1457336828
Name:MACDUFFIE, HEATHER L (PHD, LCSW)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:L
Last Name:MACDUFFIE
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 STILLWATER AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-3500
Mailing Address - Country:US
Mailing Address - Phone:207-307-7886
Mailing Address - Fax:207-433-1241
Practice Address - Street 1:444 STILLWATER AVE STE 103
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401
Practice Address - Country:US
Practice Address - Phone:207-307-7886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-08
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC68041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME2469600000Medicaid
MEME0070Medicare UPIN